Severe generalized bone pain and osteoporosis in a premenopausal black female: Effect of vitamin D replacement

A 39-yr-old black female, with a history of partial gastrectomy, presented with worsening low back and left hip pain. Initial evaluation revealed an e levated sedimentation rate, the presence of antinuclear antibodies, and the absence of rheumatoid factor. Prednisone therapy, for early seronegative r heumatoid arthritis, was of minimal benefit. A bone scan showed radionuclid e uptake in the left sacrum. Subsequent biopsy revealed a healing fracture. The pain later involved both hips, knees, feet, hands, spine, shoulders, a nd ribs. Laboratory evaluation revealed hypocalcemia, hypophosphatemia, a 2 5-hydroxyvitamin D level of 12 ng/mL (normal, 9-52 ng/mL), and an intact pa rathyroid hormone level of 304 pg/mL (normal, 10-65 pg/mL). The initial bon e density by dual energy X-ray absorptiometry of the lumbar spine was 0.871 g/cm(2) (T-score -1.81) and of the femoral neck, 0.553 g/cm(2) (T score -3 .84). Vitamin D and calcium therapy corrected the vitamin D deficiency and secondary hyperparathyroidism, with resolution of pain over the ensuing 4 m o. A repeat bone density 2 yr later revealed a 23.7% increase in the lumbar spine and a 36.2% increase in the femoral neck. Clinical osteomalacia resu lts from long-standing vitamin D deficiency. Treatment can result in resolu tion of bone pain, while producing marked increases in bone density.